Do
your veins submarine and disappear as soon as a needle hovers over your arm? Does
your blood flow, but s l o w l y? Does it take forever to get an IV solution to
run into you? Here are some things your IV nurse and phlebotomist/venipuncturist
may not tell you or think of to try...

Blood
thickens and blood pressure drops when you are dehydrated, and many people with
chronic illness are chronically dehydrated. Being forced into long-term inactivity
doesn't help matters, nor does being
hypercoagulated or having orthostatic hypotension
(hypovolemia). So, if you regularly challenge the folks who are sticking needles
into you for reasons other than a quick injection, it's a sign you need to work
on your fluid intake and, probably, your electrolytes. Skip the sweet sports drinks
and go for the pediatric electrolyte solutions (such as Pedialyte®) or, if
you need to do electrolytes regularly, Vitalyte
is a lot less expensive, even with shipping, than the generic pediatric electrolyte
solutions you find in the drugstore and grocery stores. If nothing else, on days
you are scheduled to have blood drawn or get an IV, drink a quart or more of water
or electrolyte solution in the hour or two before your scheduled appointment.
And be sure to drink afterwards, too!

Another
trick to get things flowing is to warm up. The warmer you are--or, more importantly,
your arm is--the easier it is to find and use a nice juicy vein. The same goes
for finding a place to plug in an IV. Next time you schedule an IV, ask the IV
nurse if they have heating pads on hand so that you can come in 15 minutes or
so early and get your arm warmed up. If you are going to a lab to have blood drawn,
call and ask if they have any heating pads available for you to use. If they don't,
stop at your local sporting goods or outdoor/camping store and pick up some heat
packs you can activate when needed. You may be able to find some single use heat
packs in the first aid aisle of grocery stores and drugstores. Some reusable ones
just need to be reheated in the microwave or boiling water (be sure to read and
follow the directions first!).

When
your kidneys are sloshing and your arms feel like they are in the middle of the
desert at high noon in mid summer, and the arm veins still won't cooperate,
ask the phlebotomist to use an alternative site for her sticks. In my case, the
veins on my hands are always easily accessible and free flowing, no matter how
many unsuccessful sticks have been made in the same arm. For some reason, most
phlebotomists don't think of using alternative sites for their sticks.

[In one notable case, the
stubborn phlebotomist drilled into nine different sites on both arms before he
finally agreed to try my hand. But at least that episode turned out better than
the first time someone used my hand: the blood literally gushed out and sprayed
across a 6 ft. long table and splashed on the soldier sitting at the other end...I
was in Israel at the time, in 1974, working on a kibbutz on the Jordan border.
The brilliant red geyser, which also liberally sprayed the white enameled table,
walls, floor and the nurse's clothing, completely freaked out both the nurse and
the soldier. I hasten to clarify that that was the only time my hand gushed, possibly
the result my blood pressure being rather high due to the stress of the situation
by that time and/or the stick being rather overly enthusiastic as the nurse decided
there was nothing to lose by humoring the crazy American girl.]

Many people's blood pressure goes up just going to the doctor for a routine checkup,
so it is understandable that it rises when we go to the doctor or lab because
we are sick. Stress increases the blood pressure and constricts the veins, making
it more difficult to draw blood. To reduce the likelihood of stress making your
veins more difficult to find and draw from, learn some relaxation techniques that
work for you, and put them to use as soon as you sit down in the waiting room,
and keep doing them throughout the draw.

If
you are in a facility where there is more than one phlebotomist, and the one working
on you has poked you three or four times unsuccessfully, you can nicely ask if
there is someone else who can try. Everyone can have an off day, now and then,
and it may just be one for the person working on you.

If
blood draws are always painful, there is a pediatric topical anesthetic agent
that can be used, though it is not typically used for blood draws. EMLA
Cream (lidocaine 2.5% and prilocaine 2.5%) must be applied to the draw site
1-2 hours before the draw.

Finally,
using the right sized needle is important. The needle bore (gauge) must be wide
enough to allow the blood to flow in without breaking (lysing) and of the cells,
but small enough to slip easily into the vein without cutting it or going right
through it. One of the reasons an adult patient may be a difficult draw is because
the veins are smaller than expected. In that case, the phlebotomist should be
willing to try a smaller needle, say, a 21-gauge butterfly that is normally used
for pediatric patients - and difficult-to-draw adults.

To
reiterate:

Drink
lots of fluids the day before and day of the blood draw.

Apply heat (compress, pad)
to the arm and blood draw site for 10-20 minutes before the draw. Dress more warmly
than you would ordinarily do for the weather that day, to keep your body surface
and skin temperature elevated a bit. You can always shed the extra layer or two
once your stick is over.

Ask
the phlebotomist to try an alternate site, such as the back of your hand.

Relax! The more you stress
about the lab visit, or anticipate a bad draw experience, or get up set while
a bad draw experience is going on, the more difficult you will make things for
yourself and the phlebotomist.